Distraction from pain can help or hurt

A dictionary definition of “distraction” is the “act of distracting or the condition of being distracted.” It appears that distraction is active or passive. Pain distraction or distracting pain is a controversial medical subject, but also one that is the subject of considerable research.

I first learned about pain distraction early on while in rural practice – not in medical school or formal training. A caller, the owner and publisher of the county newspaper, requested my assistance in giving one of his equines an injection. The owner needed help drawing up the medication and getting the dosage correct. My knowledge of horses was meager, but I knew that they evolved over eons as herbivores living among carnivores. A spooked horse can come apart in a heartbeat or go sideways at Warp 7 from trivial, unexpected or unseen stimuli.

I followed the instructions relayed from the veterinarian: Slap the horse with one hand (or the heel of the hand holding the needle) and stick the needle in on the third or fourth slap with the other hand. The slaps distract the animal from the sudden painful stimulus. In short, I was impressed. The horse hardly quivered. Pinching up the skin also works and is preferable to slapping human patients. Humans, however, are not as easily distracted.

The difference is fear. The horse can’t discern a needle and syringe from a hay or manure fork, but children and big strapping guys can – the latter sometimes go over like falling timber. Pinching the skin simultaneously with the jab works for infants and younger children – but have a parent perform the pinch.

There is scientific evidence that distraction works. In a study of 123 children ages 6 to 12 undergoing blood draws, the subjects were divided into two groups. Both had equal pre-procedural anxiety, but the group distracted with distraction cards (DistrACTION and Flippits are two brands) experienced less pain.

Another study used the cold pressor test to observe distraction directly. All subjects immersed one hand in ice water (the pain stimulus). Then one group took the Maze reading comprehension test (the distraction) while the second did not. Regional brain blood flow was monitored in both groups by positron emission tomography (PET) scanning. Activity in pain reception areas (somatosensory) of the brain was lower in subjects distracted by the Maze test, and subjectively, they also had less pain.

There is a flip side to the story. Every emergency room doctor and trauma surgeon knows that severe pain may mask lesser pain in trauma patients. Pain from multiple rib fractures, long bone or pelvic fractures may distract from, or overshadow, a neck injury.

Years ago, passing through a ski-patrol triage room, I saw a kid with a deformed, broken wrist. Later, as I transited our nearby ER, I saw the same kid, now alone, pale and sweaty. When asked if he hurt anywhere else, he pointed to his lower left ribs. I notified the staff members. The wrist could wait, but not the ruptured spleen.

Whether human or horse, distracting pain either can help or hurt.

www.alanfraserhouston.com. Dr. Fraser Houston is a retired emergency room physician who worked at area hospitals after moving to Southwest Colorado from New Hampshire in 1990.